Journal «Angiology and Vascular Surgery» • 

2020 • VOLUME 26 • №4

Treatment of patients with a cerebral arterial aneurysm and stenosis of the internal carotid artery

Khripun A.I.1, Asratyan S.A.3, Pryamikov A.D.1,2, Mironkov A.B.1,2, Suryakhin V.S.4, Gulina L.D.5

1) Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Pirogov Russian National Research Medical University,
2) Department of Vascular Surgery,
3) Department of Neurosurgery,
4) Intensive Care Unit for Patients with Acute Cerebral Ischaemia, Municipal Clinical Hospital named after V.M. Buyanov under the Moscow Healthcare Department,
5) Municipal Polyclinic №170 of the Moscow Healthcare Department, Moscow, Russia

Aim. The purpose of this study was to analyse the world literature dedicated to the problem concerning treatment of a combination of internal carotid artery stenosis at the extracranial level and an arterial aneurysm of the brain, as well as to demonstrate own results of surgical treatment of patients presenting with this concomitant pathology of the carotid basin.

Patients and methods. From 2013 to 2019, a clinical course of combined pathology of the basin of the internal carotid artery (an intracranial aneurysm and stenosis of the internal carotid artery at the extracranial level) was revealed in 35 of 1638 examined patients. There were ten men and 25 women, with a mean age of 66±7 years. In all the 35 patients, intracranial aneurysms appeared to be asymptomatic and were revealed during diagnosis of an atherosclerotic lesion of the internal carotid artery. Fifteen (43%) of the 35 patients were operated on. A two-stage surgical approach was used in 2 patients with ipsilateral location of the cerebral aneurysm and stenosis of the internal carotid artery: the first stage consisted in clipping of the arterial aneurysm, with stage 2 being carotid endarterectomy. A vascular stage alone (carotid endarterectomy or stenting of the internal carotid artery) was carried out in 9 patients, with a neurosurgical stage alone (clipping of the aneurysm) in 4 patients.

Results. The incidence of internal carotid artery stenosis with an arterial cerebral aneurysm, according to our findings, amounted to 2.1%. In the group of surgical treatment, in 1 case (6.7%) after stenting of the symptomatic stenosis of the internal carotid artery a female patient with an ipsilateral asymptomatic aneurysm of the middle cerebral artery intraoperatively developed “minor” ischaemic stroke. Neither perioperative aneurysmal ruptures nor lethal outcomes were observed in the group of patients subjected to surgical interventions.

Conclusions. An individual tactical approach to patients presenting with a combination of a cerebral aneurysm and internal carotid artery stenosis at the extracranial level made it possible at this stage of the work to avoid both intracranial haemorrhagic complications and lethal outcomes. The frequency of perioperative ischaemic cerebral events amounted to 6.7%. Further collection of the clinical material is needed to work out an optimal surgical policy in a combined lesion of the extra- and intracranial basin of the internal carotid artery.

KEY WORDS: internal carotid artery stenosis, arterial cerebral aneurysm, combined pathology, approaches to treatment.

P. 84

« Back